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Sharps injury prevention
Needlesticks, scalpels, and glass

Premier's commitment

Premier has a long-standing commitment to worker safety, including prevention of occupational needlestick injuries. This website assembles a wide array of resources to assist healthcare organizations eliminate sharps-related injuries. Many of these resources were developed by the Premier Safety Institute® and include:

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Introduction to sharps injury prevention resources

This website provides information, tools, and strategies to reduce workers' exposure to blood and body fluids of patients infected with bloodborne pathogens, such as HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). The greatest risk for workers is posed by percutaneous injuries (e.g., needlesticks and injuries from other sharp devices).

Overview of website: Each tab in the left navigation bar guides you to essential documents such as the CDC's sharps injury prevention workbook. The OSHA program addresses not only the bloodborne standard requirements but also supplemental implementation materials. Key agencies such as CDC, NIOSH and FDA provide major links to bloodborne pathogen information, guidelines, prevention and treatment, while Resources and tools complements OSHA's program with other materials for program implementation and training. The association between worker and patient safety is well established, and Safe injection practices serve to protect everyone involved with the use of sharps.

Premier's Safety Institute provides unique resources such as Premier's "Needlestick Prevention Educational Brochure" that is intended for use in all healthcare delivery settings. Premier's research on device field evaluations remains useful today for identifying important features when evaluating devices. Premier's current list of safety devices is available as well as member access to contracted suppliers.

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Risks of occupational bloodborne infection

Following a needlestick or other percutaneous injury from a sharp object (e.g., lancet, scalpel, broken glass), the risk of developing an infection will depend on the infectious status of the patient, the immune status of the worker, the severity of the needlestick injury, and the availability and use of appropriate post-exposure prophylaxis. CDC provides current information regarding post exposure prophylaxis and also links to the National Clinician's Consultation Center's Hotline providing rapids response to injuries.

Comprehensive information on occupational injury statistics, transmission risk, and disease outcomes for HIV, HBV, and HCV can be found in detail within the "CDC Workbook for designing, implementing, and evaluating a sharps injury prevention program" and more information about the workbook including educational slides, video, posters, and 2-page CDC worker training pamphlet address all of these basic issues. For additional information about CDC resources see Key Agencies.

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OSHA regulatory requirements

Federal OSHA and state laws have moved needlestick prevention to the top of the safety agenda. Selecting, evaluating and adopting safety devices require collaboration among many individuals in the healthcare setting, including front-line workers. To ensure a successful program each healthcare facility and care setting will need to tailor its approach to the specific risks and characteristics of the clinical environment and the needs and preferences of the workers. See the OSHA Program for additional information and strategies for implementation.

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Overview of current technology

Thousands of U.S. patents have been issued since 1984 for needles and other medical devices that incorporate injury prevention features. All major medical device companies in the United States have marketed devices with safety features as alternatives to conventional devices. It is estimated that 85 percent of injuries are preventable with currently available technology.

Safety devices shown to decrease risk: Devices with safety features have been shown in numerous studies to reduce the frequency of needlestick injuries, but for many reasons they do not completely eliminate it. In some cases, the safety feature cannot be activated until the needle is removed from the patient. Some healthcare workers may fail to activate the safety feature; users can bypass the safety feature; or the safety feature may fail. It is important to understand the factors that influence the safety of a device in order to plan effective needlestick prevention programs. Devices with safety features can reduce needlestick injuries when used in combination with a comprehensive prevention program.

Improvements in technology: Technology continues to emerge, and many of the sharps injury prevention devices have moved into second- or third-generation technology with continuous improvements in design and performance.

Safety device features 10 times more effective in preventing needlesticks: Knowledge of the most effective designs is important, both to guide the choice for users among available devices and to guide manufacturers in developing new safety technology. According to a recent study by Tosini conducted in 61 French hospitals, safety engineered devices that automatically or semi-automatically activate the safety feature were found to be 10 times more effective in preventing needlestick injuries, compared to fully manual devices requiring active engagement of the safety feature, This is one of the largest multi-center studies comparing one sharps safety device to another. More information on Tosini study. Completely "passive safety devices" do not require any action by the user to engage a safety feature. One example of a passive device is the blunt-tipped suture needle which FDA, OSHA and NIOSH/CDC now recommend for suturing fascia and muscle tissue.

Use of safety devices has risen dramatically in past decade: There has been a dramatic rise in the use of safety devices compared to conventional (non-safety) devices to prevent needlesticks and other sharps-related injuries. According to industry estimates, from 1998 to 2009 the use of safety devices in all US healthcare settings has risen from: 10 percent to 97 percent for IV catheters; 10 percent to 85 percent for phlebotomy devices; and 28 percent to 80 percent for syringes and needles. Hospitals are reported to have a higher rate of conversion to all types of safety devices compared to non-hospital healthcare settings.

Conventional needles may still be needed: For syringes, the conversion rates to safety devices may never reach 100 percent because conventional syringes (non-safety) are still allowed to be purchased and used for procedures that do not result in contamination of the syringe or are not used on patients, e.g., used for sterile medication preparation in pharmacy or for injection into needleless access ports on intravenous lines. Some safety needles are not available in all sizes. It will be important to document those situations where conventional needles and devices may still be appropriate because there is no exposure to blood or other potentially infectious materials or where no alternative exists.

Time investment for product evaluation: Proper evaluation of these sharps injury prevention devices is an important part of the process. Numerous tools are available for conducting evaluations, educating staff on proper use, collecting and analyzing data on effectiveness, and implementing a device facility-wide in all applicable care delivery sites. Front-line workers need to be included in the identification, evaluation and selection of the safety devices. There is no formula for how many devices need to be evaluated or for what length of time. Each facility must determine this based on its own needs and the preferences of the workers. See OSHA program and Resources and tools.

Cost effectiveness of safety devices: The precise cost of needlestick injuries cannot be quantified in terms of dollars but represent pain and suffering for the worker and the potential for significant losses for an institution. The emotional trauma for the worker, family and friends following a needlestick injury can be devastating. Direct and indirect costs for the facility include post-exposure medical follow-up, lost worker time or replacement costs, disability, and OSHA citations and fines. The organization must also consider the negative impact the event can have on the morale of the workers.

The goal of implementing safety devices is to protect workers from exposure to bloodborne pathogens. It has been suggested that the cost of safety devices may be offset by a reduction in the direct costs associated with post-exposure medical follow-up and treatment of needlestick injuries. However, it is important to note that it remains extremely difficult to show direct cost savings.

Sharps waste reduction strategies: As healthcare moves towards more responsible environmental policies, many healthcare facilities are looking for ways to reduce their waste, particularly regulated medical waste that represents a significant cost factor. There are sound strategies to safely reduce waste in healthcare and Premier has resources to aid in these efforts.

Reusable sharps containers can reduce waste while ensuring the safety of patients, workers and the environment. Premier provides information on some sharps disposal containers suppliers in its list of sharp injury prevention devices as examples of acceptable alternatives for disposal that can reduce sharps waste volume.

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Sharps safety devices from Premier

Many safety devices designed to prevent sharps injuries -- including syringes, phlebotomy devices, lancets, vascular access devices, suture needles, and sharps disposal containers -- are available through Premier's contracts with a wide variety of contracted suppliers. Additional information may be obtained at the website from Premier's electronic catalog, available to Premier members with a password.

OSHA's Bloodborne Pathogen Standard requires employers to solicit input from non-managerial, frontline workers responsible for direct patient care on the identification, evaluation and selection of effective engineering controls/devices to prevent sharps-related injuries, whether or not they are covered by a group purchasing contract.

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